Methods of making self-sealing patches for tissue expander implants

ABSTRACT

A method of making a self-sealing patch for a tissue expander implant includes providing a first sheet having a first sheet outer perimeter and a first sheet inner edge defining a first central opening, providing a second sheet having a second sheet outer perimeter and a second sheet inner edge defining a second central opening, aligning the first and second sheet outer perimeters and the first and second sheet inner edges, capturing an outer washer between the first and second sheet outer perimeters for attaching the first and second sheets together, and capturing an inner washer between the first and second sheet inner edges for attaching the first and second sheets together. The method includes spacing an inner perimeter of the outer washer from an outer perimeter of the inner washer to form a sealed annular space between the attached first and second sheets, and disposing a hydrophobic material within the sealed annular space.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present patent application is a continuation of commonly assignedU.S. patent application Ser. No. 13/830,547, published as US2014/0277440, now allowed, the disclosure of which is herebyincorporated by reference herein.

BACKGROUND OF THE INVENTION

The present invention relates to implantable tissue expanders andprostheses. Although the tissue expanders may be used in other areas ofthe body, one specific application of the inventive subject matter areimplantable mammary soft tissue expanders.

Tissue expanders are devices that are implanted beneath the skin andthen gradually inflated to stretch the overlying tissue. Expanders arecommonly used either to create a pocket for receiving a permanentprosthesis or to generate an increased skin surface area in anticipationof the new skin being utilized for grafting or reconstruction.

Conventional implantable tissue expanders are formed of a siliconepolymer shell. After implantation, a fluid such as saline isperiodically injected into the expander for expansion. Betweeninjections, the surrounding skin is permitted to stretch and grow tocreate the increased skin surface.

The saline or other fluid may also be withdrawn from the expander toreduce its volume. In addition, the shell can be partially filled withfluid or gel prior to implantation.

Typically, a tissue expander will be provided with an injection dome,for example, a dome comprising a septum that can be pierced with ahypodermic needle for the introduction of fluid directly into theexpander or withdrawal of fluid directly from the expander. However, itcan be difficult to accurately locate the injection dome through theoverlying tissue. If the injection dome is missed and the needlepunctures the shell of the tissue expander adjacent to the injectiondome, the expander can leak. Most often, any leaking requires that theexpander be removed and replaced.

This problem can be addressed by providing an injection dome that isremote from the tissue expander but is in fluid communication with theexpander. Other solutions include eliminating the need for an injectionsite altogether by forming the expander with a self-sealing shell thatcan be pierced with a hypodermic needle at any location for the purposeof adding fluid to the shell.

Still further solutions include providing an injection dome surroundedby a self-sealing member that reduces the risk of causing a leak in thetissue expander in the event that the hypodermic needle used to fill theexpander accidently misses the injection dome. Such an arrangementreduces the frequency with which expanders require removal due toleakage caused by inadvertent punctures. It is this type of arrangementthat is the focus of the present invention, which draws on the teachingsof U.S. Pat. No. 6,743,254, the disclosure of which is herebyincorporated by reference herein.

SUMMARY OF THE INVENTION

Although well received, systems and methods of the types described aboveare not ideal. Particularly with respect to injection domes surroundedby self-sealing members, it has been found that the conventionalself-sealing members are stiff and may be perceived as beinguncomfortable for some patients. It has also been found that theinjection domes are difficult for medical staff to locate.

The present invention therefore provides for a tissue expander having aninjection dome surrounded by a self-sealing member with improvedfeatures. These features include self-sealing patches that are moreflexible and softer than conventional patches. The features also includethe removal of a palpitation ring and incorporation of a strongerlocating magnet that aids in medical staff identifying the properlocation for the filling hypodermic needle.

In accordance with one aspect of the invention, there is provided atissue expander comprising an outer shell configured to retain a fluid;an injection dome comprising a self-sealing septum region arrangedthrough the outer shell, the injection dome adapted to accept ahypodermic needle to fill the outer shell with fluid; a self-sealingpatch arranged around the injection dome and along the outer shell, theself-sealing patch comprising a first sheet having a first sheetperimeter and forming a first central opening; a second sheet having asecond sheet perimeter and forming a second central opening; an outerwasher arranged between the first and second sheets at the first sheetperimeter and the second sheet perimeter; and a second washer arrangedbetween the first and second sheets at the first central opening and thesecond central opening. The first sheet and the second sheet bound anannular space formed between the outer washer and the inner washer, theannular space filled with a self-sealing material.

The self-sealing patch may be arranged on an inner surface of the outershell.

The injection dome may further comprise a magnetized area of between 650gauss and 13,000 gauss at 5 mm.

The self-sealing material in the annular space may be hydrophobicmaterial having a viscosity high enough that the material is preventedfrom flowing outside the pocket when either the first or second sheet ispunctured with a hypodermic needle but low enough that the materialflows to close a track made by a hypodermic needle puncturing the firstor second sheet. Such hydrophobic material may be one of a liquidsilicone rubber, cohesive gel, sensitive gel, or memory gel.

In accordance with a further aspect of the invention, a self-sealingpatch for use with a tissue expander implant comprises a first sheethaving a first sheet perimeter; a second sheet having a second sheetperimeter attached to the first sheet perimeter to form a pocket betweenthe first sheet and the second sheet; material disposed within thepocket, wherein the material is hydrophobic material having a viscosityhigh enough that the material is prevented from flowing outside thepocket when either the first or second sheet is punctured with ahypodermic needle but low enough that the material flows to close atrack made by a hypodermic needle puncturing the first or second sheet.

The hydrophobic material may be one of a liquid silicone rubber,cohesive gel, sensitive gel, or memory gel.

The first sheet may be formed from a low bleed silicone patch materialcomprising three layers having an overall thickness of betweenapproximately 0.014″ to 0.090″. The first sheet may be formed from amaterial comprising a polydiphenylsiloxane layer betweenpolydimethysiloxane layers.

The first sheet may be formed from a material made from vulcanizedpolydimethylsiloxane with a thickness of approximately 0.004″ to 0.010″.

The first sheet may be formed from a material made from unvulcanizedpolydimethylsiloxane with a thickness of approximately 0.004″ to 0.010″.

The first sheet may be formed from polyethylene terephthalate reinforcedvulcanized polydimethylsiloxane with a thickness of approximately 0.013″to 0.018″.

The first sheet may be reinforced with a Polyethylene terephthalate(PET) mesh.

The first sheet may be reinforced with a third sheet of para-aramidsynthetic fibers.

The self-sealing patch may further comprise an outer washer disposedbetween the first sheet perimeter and the second sheet perimeter toattach the first sheet perimeter to the second sheet perimeter.

The self-sealing patch may further comprise a central opening within thefirst sheet perimeter and the second sheet perimeter, the centralopening formed by a washer located between the first sheet and thesecond sheet.

In accordance with a still further aspect of the invention, a method offorming a self-sealing patch for use in a tissue expander implantcomprises, in no particular order, forming a first sheet by pressingsilicone in a calendaring process; partially curing the first sheet;forming a second sheet by pressing silicone material in a rollingmachine; fully curing the second sheet; attaching the first sheet to thesecond sheet with silicone washers to form an annular space; and fillingthe annular space with a self-sealing material.

The method may further comprise reinforcing the first sheet with a PETmesh.

The step of forming the second sheet may include pressing the siliconematerial with a PET mesh.

The step of partially curing the first sheet may leave a first side ofthe first sheet tacky.

BRIEF DESCRIPTION OF THE DRAWINGS

The subject matter regarded as the invention is particularly pointed outand distinctly claimed in the concluding portion of the specification.The invention, however, both as to organization and method of operation,together with features, objects, and advantages thereof, will be orbecome apparent to one with skill in the art upon reference to thefollowing detailed description when read with the accompanying drawings.It is intended that any additional organizations, methods of operation,features, objects or advantages ascertained by one skilled in the art beincluded within this description, be within the scope of the presentinvention, and be protected by the accompanying claims.

With respect to the drawings,

FIG. 1 is a perspective view of an exemplary tissue expander implantwith self-sealing safety patch;

FIG. 2 is a cross-sectional view of the tissue expander of FIG. 1;

FIG. 3 is a cross-sectional view of the injection port of the tissueexpander of FIG. 1;

FIG. 4 is an exploded view of the safety patch of FIG. 1; and,

FIG. 5 is a cross-sectional view of the safety patch of FIG. 1.

DETAILED DESCRIPTION

In the following are described the preferred embodiments of the tissueexpander implant with self-sealing safety patch of the presentinvention. In describing the embodiments illustrated in the drawings,specific terminology will be used for the sake of clarity. However, theinvention is not intended to be limited to the specific terms soselected, and it is to be understood that each specific term includesall technical equivalents that operate in a similar manner to accomplisha similar purpose. Where like elements have been depicted in multipleembodiments, identical reference numerals have been used in the multipleembodiments for ease of understanding.

As discussed above, the invention features a tissue expander implantwith self-sealing safety patch. The self-sealing safety patch surroundsan injection dome to aid with sealing of the tissue expander implantupon inadvertent placement of a filling hypodermic needle outside of theinjection dome.

Although the tissue expander with self-sealing safety patch of thepresent invention may be utilized for any tissue expander, the followingdescription is provided for its use in a mammary tissue expander.Typically, such an expander will be placed in the body submuscularly,primarily beneath the pectoralis major, pectoralis minor, and/orserratus anterior, subcutaneously, or subglandularly.

FIG. 1 depicts a perspective view of a mammary tissue expander inaccordance with one embodiment of the present invention. As shown, theexpander 10 includes an outer shell 12, preferably made of across-linked silicone elastomer. The outer shell 12 includes aninjection dome 14. A fluid dispensing device, such as an injectionsyringe (not shown), is used to add or remove fluid from the outer shell12 through the injection dome 14 to adjust the shell's volume. Thepresent invention protects the integrity of the expander 10 by providinga safeguard against a syringe failing to penetrate the injection dome14, but rather entering the outer shell 12 in the immediate areaadjacent the injection dome 14. It does so by providing a self-sealingsafety patch 16 in the immediate vicinity surrounding the injection dome14.

Typically the self-sealing safety patch 16 will be oval or round. Itwill be appreciated that the size of the self-sealing safety patch 16may be scaled depending on, and in relation to, the size of the outershell 12.

FIG. 2 depicts a cross-sectional view of the mammary tissue expander 10of FIG. 1. Again, the mammary tissue expander 10 includes an outer shell12 with an injection dome 14. Also shown is the self-sealing safetypatch 16 formed around the injection dome 14.

FIG. 3 is a cross-sectional view of the injection dome 14 depictingadditional details thereof. The function of the injection dome 14 is toallow controlled introduction and removal of fluid to and from thetissue expander 10. Generally, this is accomplished through use of ahypodermic needle (not shown) that pierces a selected region of theinjection dome 14, e.g., septum region 18 formed of elastomericmaterial. The injection dome 14 is fitted into an opening in the outershell 12, for example at a portion which is intended to face the skin ofthe patient to be expanded. The casing 20 of the injection dome istypically formed of an elastomeric material.

The septum region 18 of the casing 20 is preferably located at thecentral region of the upper surface of the casing. The septum region 18is self-sealing, preventing the leaking of fluid from the implant 10after removal of the hypodermic needle from the injection dome. A flange22 extends around the upper edge of the dome casing 20. As shown moreclearly in FIG. 2, the flange 22 overhangs the shell 12, which ispartially sandwiched between the flange and the self-sealing safetypatch 16. As the flange 22 rests against the outer surface of the shell12, it provides a surface for securely attaching the assembled injectiondome 14 to the shell.

In order to prevent accidental puncture of the shell 12 through theinjection dome 14 itself, the injection dome is equipped with a needleguard 24 in the form of a metal cup forming a base portion 26 and a rimportion 28. The rim portion 28 is fitted into to an annular slot 30 inthe underside of the dome casing 20. When the needle guard 24 isinserted into the slot 30 in the injection dome 14, compressive force isexerted on the elastomeric material of the septum region 18 of theinjection dome 14. As a result of these forces, the septum region 18 ofthe injection dome 14, is self-sealing. Openings 32 in the rim portion28 of the needle guard 24 allow fluid to pass to the interior of theshell 12.

A needle damper 34, preferably formed of a resilient material, e.g.,polysulfone, is positioned on top of the base 26 of the needle guard 24to prevent damage to the hypodermic needle tip should the needle beinsert so far as to actually strike the needle guard. It is prudent toreduce the risk of damage to the hypodermic needle because a bent tipcould tear a non-repairable hole that compromises the self-sealingcapability in the septum region 18 upon withdrawal of the needle fromthe injection dome 14. The needle damper 34 is preferably adhesivelyfastened to the needle guard 24.

The injection dome 14 can be modified in various ways to help themedical professional accurately locate the septum region 18 beneath theskin of the recipient. For example, the dome can include a raised“palpation” ridge (not shown) that encircles the actual septum region18. The injection dome can also, or alternatively, be provided with amagnet, e.g., a magnet 36 attached to the needle guard 24, that allowsthe injection dome 14 to be located by passing a device capable oflocating a magnetic field over the patient's skin. Unlike prior artmagnets that are generally in the range of 414 gauss at 5 mm, magnets 36of the present invention are preferably 650 gauss or greater at 5 mm.Preferably, these magnets are less than 13,000 gauss at 5 mm. Thisprovides a stronger magnetic field for the medical professional tolocate the septum than previously known. This is useful particularlywhere there are no “palpation” ridges in the injection dome 14.

The outer shell 12 of the tissue expander of the invention can have anydesired shape and any thickness that is suitable for the purpose of theparticular expander. The shell may be single lumen or multi-lumen and iscommonly formed of a biocompatible elastomer, e.g., silicone. Dipmolding using an appropriately sized and shaped mandrel can be used toform the outer shell 12. The mandrel is dipped into silicone dispersionand then removed to allow partial cure or solvent evaporation. Theprocess is generally repeated several times. Once the outer shell 12 hasbeen formed it is removed from the mandrel. (Other methods such asinjection molding or spraying may also be used to form the shell.)

This dip molding process results in the formation of a partial shellthat has an opening, e.g., a circular hole (patch hole) on its face. Theself-sealing patch 16 is applied to the inner or outer surface of theouter shell 12, e.g., in the region that will surround the injectiondome 14. The injection dome 14 is installed and the patch hole issubsequently covered with a patch that seals the hole, thus forming acomplete, fluid impervious shell. The patch is attached to the partialshell using silicone rubber or other similar biocompatible adhesive. Thecompleted shell can either be non-filled or partially pre-filled. Afterimplantation, the expander 10 is intraoperatively filled through theseptum region 18 with saline, gel, foam, or combinations of thesematerials or other suitable materials known in the art to graduallyexpand the tissue expander to the desired dimensions.

FIG. 4 depicts an exploded view of a self-sealing patch 16 in accordancewith the present invention. As shown, the self-sealing patch iscomprised of four major components. At one end of the self-sealing patch16 is a first sheet 52 and at a second end of the self-sealing patch isa second sheet 54. The first sheet 52 includes a first perimeter 56around the exterior circumference thereof while the second sheet 54includes a second perimeter 58 around its exterior circumference. Eachof the first sheet 52 and second sheet 54 includes an aperture region60, 62 respectively, formed generally in each sheet's central portion.

Between the first sheet 52 and second sheet 54 are an outer washer 64and an inner washer 66. The outer washer 64 has an outer perimeter 68corresponding to the first and second perimeters 56, 58 and ispreferably approximately 5 mm thick (measured between its inner andouter diameters). The inner washer 66 includes an inner perimeter 70corresponding to the edges 72, 74 of the aperture regions 60, 62 and isalso approximately 3 mm thick.

When pressed together, the first sheet 52 and second sheet 54 capturethe washers 64, 66 to create an annular space 76, or pocket (see FIG.5), between the four elements. This annular space 76 is preferablyfilled with a substance that will self-seal, for example a substancethat is hydrophobic having a viscosity high enough that the material isprevented from flowing outside the annular space when either the firstor second sheet is punctured with a hypodermic needle but low enoughthat the material flows to close a track made by a hypodermic needlepuncturing the first or second sheet. Typically this property ismeasured as a function of stiffness/firmness and cohesion, with apenetration value of approximately 3-10 mm. Hydrophobic materials arechosen because hydrophilic materials may open the tissue expander togreater osmotic exchange with the local environment than a hydrophobicmaterial.

Substances suitable for filling the annular space 76 include:

-   -   Liquid silicone rubber (LSR).    -   Cohesive gel. It is noted that cohesive gel is available        commercially as manufactured at least by Mentor Worldwide LLC.    -   Sensitive gel. It is noted that sensitive gel is available        commercially as manufactured at least by Mentor Worldwide LLC.    -   Memorygel® as produced by Mentor Worldwide LLC. Memorygel® is a        registered trademark of Mentor Worldwide LLC, 5425 Hollister        Avenue, Santa Barbara, Calif. 93111.

Once the patch is filled, a small amount of silicone adhesive can beused to seal the entry point of the filling mechanism.

The first and second sheets 52, 54 of the patch 16 are preferablysimilarly sized oval sheets. It will be appreciated that the patchdimensions and the dimensions of each part can be scaled based onimplant size and profile. Typically, the patch 16 will exceed the boundsof the injection dome 14 on each side of the injection dome.

The first and second sheets 52, 54 are each typically manufactured frommatching materials, but can be formed from different combinations ofmaterials. Among the suitable materials are:

-   -   Low bleed silicone patch material comprising three layers having        an overall thickness of approximately 0.014″ to 0.090″.    -   Material that comprises a polydiphenylsiloxane layer between        polydimethysiloxane layers.    -   Vulcanized or unvulcanized polydimethylsiloxane with a thickness        of approximately 0.004″ to 0.0192″. A specific example of this        arrangement is the use of NuSil® MED4750 silicone, which is a        1:1 blend of a two part system. Part A of the system contains a        base polymer functionalized with vinyl groups and containing a        platinum catalyst. Part B of the system contains the silyl        hydride crosslinker. NuSil® is a registered trademark of Nusil        Technology LLC, 1050 Cindy Lane, Carpinteria, Calif. 93013.

Additionally, any of the aforementioned materials may be reinforced witha Polyethylene terephthalate (PET) mesh. The materials may also bereinforced with a sheet made from para-aramid synthetic fibers. Withthese reinforcements, the sheet thickness may rise to approximately0.013″ to 0.018″ or greater.

In one particular example, the two sheets 52, 54 are made as follows.The first sheet 52, reinforced with a PET mesh, is made by pressingblended NuSil® 4750 silicone material in a calendaring process. Thissheet is partially cured to leave one side tacky for attaching to theimplant shell. The second sheet is made by pressing blended NuSil® 4750silicone material along with a PET mesh on one side in a rollingmachine. This PET sheet is fully cured.

The first and second sheets 52, 54 are attached to each other using thetwo washers 64, 66, which are formed from silicone. Washer 64, aligningwith the first and second perimeters 56, 58 is 5 mm in width. The washer64 is preferably formed from unvulcanized NuSil® MED 4750 material, butmay also be formed from other materials such as 4735. The washer 66aligned with the aperture regions 60, 62 is cut from unvulcanizedsheeting preferably made from NuSil® MED 4750. The washer may also beformed from other materials such as 4375. The washers 64, 66 thereafteract to form a sealed annular space 76. The pocket is then filled withany of the suitable substances identified above.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

What is claimed is:
 1. A method of making a self-sealing patch for atissue expander implant comprising: providing a first sheet having afirst sheet outer perimeter; providing a second sheet having a secondsheet outer perimeter; attaching said first sheet to said second sheetwith washers made of silicone to form a self-sealing patch having asealed annular space; filling said sealed annular space with aself-sealing material; attaching said self-sealing patch to a surface ofan outer shell having an adjustable volume and configured to retain afluid; wherein said self-sealing material is hydrophobic material havinga viscosity high enough that said material is prevented from flowingoutside said sealed annular space when either said first or second sheetis punctured with a hypodermic needle but low enough that said materialflows to close a track made by a hypodermic needle puncturing said firstor second sheet; and wherein there are no layers of fabric between saidfirst and second sheets; and.
 2. The method as claimed in claim 1,wherein the providing said first sheet comprises forming said firstsheet by pressing silicone in a calendaring process and partially curingsaid first sheet, and wherein the providing said second sheet comprisesforming said second sheet by pressing silicone material in a rollingmachine and fully curing said second sheet.
 3. The method as claimed inclaim 2, further comprising reinforcing at least one of said first andsecond sheets with a Polyethylene terephthalate (PET) mesh.
 4. Themethod as claimed in claim 2, wherein the step of partially curing saidfirst sheet leaves a first side of said first sheet tacky.
 5. The methodas claimed in claim 2, wherein the step of forming said second sheetcomprises pressing the silicone material with a PET mesh.
 6. The methodas claimed in claim 1, wherein said washers comprises silicone.
 7. Themethod as claimed in claim 1, further comprising: forming a firstcentral opening in said first sheet to define a first sheet inner edgethat surrounds said first central opening, wherein said first sheetinner edge is spaced from said first sheet outer perimeter; forming asecond central opening in said second sheet to define a second sheetinner edge that surrounds said second central opening, wherein saidsecond sheet inner edge is spaced from said second sheet outerperimeter; and aligning said first central opening with said secondcentral opening.
 8. The method as claimed in claim 7, wherein thealigning step comprises: aligning said first sheet inner edge with saidsecond sheet inner edge; and aligning said first sheet outer perimeterwith said second sheet outer perimeter.
 9. The method as claimed inclaim 8, wherein the attaching step comprises: capturing an outer washerbetween said first sheet outer perimeter and said second sheet outerperimeter; and capturing an inner washer between said first sheet inneredge and said second sheet inner edge.
 10. The method as claimed inclaim 9, wherein an outer perimeter of said outer washer is aligned withsaid first and second outer perimeters of said respective first andsecond sheets, and wherein an inner perimeter of said inner washer isaligned with said first and second inner edges of said respective firstand second sheets.
 11. The method as claimed in claim 10, wherein saidsealed annular space extends between said first and second sheets andfrom said inner perimeter of said outer washer to said outer perimeterof said inner washer.
 12. The method as claimed in claim 1, furthercomprising: positioning an injection dome within an opening of saidouter shell, wherein said injection dome is adapted to accept ahypodermic needle to fill said outer shell with fluid; placing saidself-sealing patch on an inner surface of said outer shell, wherein saidself-sealing patch surrounds said injection dome.
 13. The method asclaimed in claim 12, providing a magnetized area on said injection domeof between 650 gauss and 13,000 gauss at 5 mm.
 14. The method as claimedin claim 1, wherein said hydrophobic material is selected from the groupconsisting of liquid silicone rubber, cohesive gel, and sensitive gel.15. A method of making a self-sealing patch for a tissue expanderimplant comprising: wherein said tissue expander implant comprises: anouter shell configured to retain a fluid; an injection dome comprising aself-sealing septum region arranged through said outer shell, saidinjection dome adapted to accept a hypodermic needle to fill said outershell with fluid; said self-sealing patch arranged around said injectiondome and along said outer shell; providing a first sheet having a firstsheet outer perimeter and a first sheet inner edge defining a firstcentral opening; providing a second sheet having a second sheet outerperimeter and a second sheet inner edge defining a second centralopening; aligning said first sheet outer perimeter with said secondsheet outer perimeter and said first sheet inner edge with said secondsheet inner edge so that said first sheet central opening is alignedwith said second sheet central opening; capturing an outer washer madeof silicone between said first sheet outer perimeter and said secondsheet outer perimeter for attaching said first and second sheetstogether; capturing an inner washer made of silicone between said firstsheet inner edge and said second sheet inner edge for attaching saidfirst and second sheets together at said first sheet central opening andsaid second sheet central opening; spacing an inner perimeter of saidouter washer from an outer perimeter of said inner washer to form asealed annular space between said attached first and second sheets;disposing a hydrophobic material within said sealed annular space;wherein said hydrophobic material having a viscosity high enough thatsaid material is prevented from flowing outside said sealed annularspace when either said first or second sheet is punctured with ahypodermic needle but low enough that said material flows to close atrack made by a hypodermic needle puncturing said first or second sheet;and.
 16. The method as claimed in claim 15, where said hydrophobicmaterial is selected from the group consisting of liquid siliconerubber, cohesive gel, and sensitive gel.
 17. The method as claimed inclaim 15, further comprising reinforcing at least one of said first andsecond sheets with a Polyethylene terephthalate (PET) mesh.
 18. Themethod as claimed in claim 15, further comprising: providing an outershell configured to retain fluid and having an adjustable volume;positioning an injection dome within an opening of said outer shell,wherein said injection dome is adapted to accept a hypodermic needle tofill said outer shell with a fluid; placing said self-sealing patch onan inner surface of said outer shell, wherein said self-sealing patchsurrounds said injection dome positioned within said opening of saidouter shell.